Grim reminders of how it began

BY DELTHIA RICKS | Newsday Staff Writer

June 4, 2006

Barry Mann is being tested for the HIV virus by his nurse, Gary Carlisle at Bellview Hospital. (Newsday / Alejandra Villa)

In Barry Mann's blood flows a secret so ancient, so intricately scripted in his genetic code, that scientists are certain if they can crack it, they may well be on the way to holding back, even reversing the global tidal wave of AIDS.

Such a puzzle is only one of many as the world marks a somber milestone: the 25th anniversary of a report describing a rare pneumonia in five gay men. It was the first evidence of a deadly new disorder, one that irreparably crippled the immune system. Within the last decade, potent drug therapy has transformed the inevitably fatal infection into a manageable disease for a third of patients in the developed world.

Still, in its quarter-century sweep, AIDS has claimed 500,000 lives in the United States, among 25 million worldwide, statistics from the Centers for Disease Control and Prevention show.

Deaths continue to mount in what indisputably is one of the worst pandemics in human history. An estimated 14,000 people become infected daily, according to pioneering AIDS researcher Dr. David Ho of the Aaron Diamond AIDS Research Center in Manhattan.

Neither a cure nor protective vaccine are anywhere in sight.

Yet the secret harbored in the 65-year-old Manhattan resident's cells could hold tantalizing clues. Mann is among a small but scientifically important group that has been exposed to the human immunodeficiency virus, but who seem surprisingly -- defiantly -- resistant.

In theory, such resistance stems from a defense some scientists suggest may have been passed down from hardy Northern Europeans who escaped the 14th century's Black Death. The trait seems to render a subset of descendants impervious to HIV.

"They think there is this Northern European gene pool that somehow survived the bubonic fleas," said Mann, who traces his ancestry to the British Isles. He is certain of his HIV exposure, having lived intimately with a man for eight years who died of AIDS in the late 1980s.

"I had to be exposed to it by him. And who knows? There were other sexual contacts and sexual partners that I had who were diagnosed as HIV-positive who also died," Mann said. "What they're trying to figure out is what it is that we have and to take it to the part of the population that can't resist it."

Mann is a volunteer in a study at NYU's Center for AIDS Research in Manhattan.

"My God, look at what's going on in Africa," Mann said. "My interest is as a humanist. I really believe that some of the greatest advances in science have been based on pretty big sacrifices that people have made. Mine is not a great sacrifice." Mann periodically donates his blood to science.

On the wane in the U.S.

As HIV transmission continues unabated in many resource-poor countries, there have been notable successes in the United States, where prevention and treatment strategies have had an impact.

CDC statistics show rates of new infections have been dropping from 150,000 confirmed infections a year in the 1980s to about 40,000 annually in recent years.

In 2004, an estimated 16,000 people in the United States died of AIDS, a disorder in which HIV infection so overwhelmingly suppresses immunity that secondary opportunistic infections lead to death.

By comparison, in 1990, before the development of highly active antiretroviral therapy, the strategy referred to as HAART, the triple-combination cocktail, nearly twice as many people succumbed to AIDS.

Other good news includes declining HIV infections among injecting drug users, whose rates have dropped from 14 percent of all cases in the 1990s to less than 2 percent now.

Perhaps the greatest success story to date, experts say, has been the dramatic decline in mother-to-child transmission. Only 300 children are born each year with HIV infection, compared with 2,000 annually in the mid-1990s. Prescribing drug therapy to pregnant women prevents viral transmission to a developing fetus.

Most of all, old-fashioned gumshoe public health efforts -- preaching the tenets of prevention -- and people heeding the message are signs that practicing safe sex and avoiding contaminated needles pays.

Dr. Timothy Mastro, acting director of the CDC's Global AIDS program, said the statistics should not invite complacency.